The Lowdown on STD’s: Chlamydia
Chlamydia is the third most common sexually transmitted infection (STI) in the United States.  It is the most common bacteria causing an STI.  According to a 2007 Center for Disease Control report, South Carolina ranks 3rd out of the 50 states in chlamydial infections.  Those at most risk of infection are single, minority women between ages 15-21 with new or multiple sexual partners.  However, Chlamydia affects women and men of all backgrounds. 

Like all sexually transmitted infections, Chlamydia enters a woman’s body during intercourse.  Chlamydia trachomatis is different from most bacteria in that it must live inside cells, making it difficult to grow in a culture. In this way, it is more similar to a virus.  Chlamydia prefers to live inside the cells of the cervix (the opening of the uterus) and the cells that line the bladder. 

Symptoms
Most women infected with Chlamydia are asymptomatic. Cervical infection may present with pain or bleeding during intercourse or a change in vaginal discharge.  Symptoms of chlamydial infection of the bladder and urethra can mimic a urinary tract infection.  Similar to women, men do not usually have symptoms.  If symptomatic, they may present with a discharge from the penis or pain during urination or ejaculation.

Diagnosis
Prenatal diagnosis and treatment of Chlamydia is extremely important. Women with untreated Chlamydia can develop postpartum fever and uterine infection.  Forty percent of babies born to mothers with untreated Chlamydia will develop eye infections.  Worldwide, Chlamydia conjunctivitis is a leading cause of preventable blindness.

The majority of cases are diagnosed during routine gynecologic exams and pregnancy screening.  At the time, physicians may note a discharge from the cervix.  Because Chlamydia does not grow in routine culture, standard diagnostic tests use nucleic acid amplification to detect the proteins that make up the bacteria.

Treatment
The CDC recommends immediate treatment of Chlamydia and encourages expedited treatment of known partners.  The most commonly prescribed antibiotics are macrolides, tetracyclines, and fluoroquinolones.  Because Chlamydia often accompanies a gonorrheal infection, patients diagnosed with gonorrhea are often treated for both.  For those in a relationship, both partners should complete treatment and wait approximately 1-2 weeks after their last dose to have sex to avoid re-infection.  Couples can also use condoms to prevent re-infection.  Condoms are the only reliable method for prevention of Chlamydia transmission.

Effects of Untreated Chlamydia
Due to the absence of symptoms, many women are unaware of current or past chlamydial infection.  Untreated Chlamydia can have devastating effects on the reproductive organs.  Although it initially infects the cervix, Chlamydia can migrate upward into the uterus and fallopian tubes. Upper genital tract infection can lead to infertility, pelvic inflammatory disease, and chronic pelvic pain. 

Women concerned they have been infected with Chlamydia or another sexually transmitted disease can be tested at their physician’s office, the state health department or a non-profit clinic such as Planned Parenthood of America.  MUSC Women’s Health offers a specialty clinic for STI testing and treatment of women and their partners.

by:  Gweneth Lazenby, M.D.

Now that I’m pregnant, can I still have sex?
This is a common question from our obstetric patients.  For most women, the answer is “yes!”  However, there are exceptions.  Many patients feel uncomfortable discussing sex or sexuality with their physicians.  The purpose of this installment is to dispel any myths and reiterate any truths concerning sex during pregnancy. 

During intercourse and orgasm, pregnant women may experience mild cramping.  This is normal and is not associated with miscarriage.  Some women experience vaginal spotting after intercourse.  Spotting is usually due to the softening and increased blood flow to the cervix and does not lead to miscarriage.  Any heavy bleeding or leakage of fluid more than semen should be reported to your physician.  It is natural to begin having breast discharge later in pregnancy.  Some women may have milky breast secretions during orgasm later in pregnancy.

Talk about it
Women’s emotional and physical bodies undergo incredible change during pregnancy.  In regards to sex, women may notice increased vaginal lubrication, engorgement or swelling of the genitals, and a change in the character of orgasm.  Some women experience more intense and more frequent orgasms during pregnancy. Despite these positive effects, women may be less interested in sex at times.

During the first trimester, women have increased fatigue and may be battling morning sickness, both of which can decrease desire.  By the second trimester, women are feeling better, but their bodies have begun to change with a noticeably growing belly.  Towards the end of pregnancy, women experience increased pelvic pressure and general discomfort.  Given all the physical and emotional factors that affect a woman’s desire to have sex, it is important for partners to communicate their changing expectations for sex during pregnancy.

Mama Sutra
For the times when it feels right, couples will certainly encounter the need to change positions to accommodate for the baby on board.  The missionary position or woman lying on her back is difficult by the second trimester due to blood flow requirements of the growing uterus.  The following positions are recognized as more conducive to comfortable intercourse while pregnant: woman on hands and knees, couple spooning, partner lying or sitting with woman on top, and partner behind with woman side lying with knees drawn to chest.  If the woman experiences vaginal dryness during pregnancy, water-based lubricants are best.  In regards to alternative forms of intimacy, manual or oral stimulation of the clitoris and vagina are safe in most pregnancies.  Sexual accessories such as vibrators and dildos can be safely used during pregnancy.  Patient’s advised to avoid vaginal or anal sex should also avoid insertion of these devices.   

Slow down Mama
Although sex is safe in the majority of pregnancies, there are conditions in which your physician may advise abstinence.  In the first trimester, these may include women experiencing bleeding or threatened miscarriage, a history of cervical incompetence, or immediately following a surgical procedure such as a colposcopy or cerclage.  Some physicians may instruct patients with a history of preterm labor, threatened preterm labor, or a dilated cervix to avoid vaginal intercourse.  All women with ruptured amniotic membranes or a placenta previa (placenta covering or near the cervix) should abstain from any penetrative intercourse. 

Sex induced contractions
At the end of pregnancy, many women are anxious to deliver and inquire into “natural” methods for inducing contractions.  Many cultures believe that sex and orgasm can induce labor.  I have reviewed the research available for term pregnancy and induction.  At this time, there is little to no evidence to suggest that vaginal sex with a male partner can lead to labor or decrease length of pregnancy.  Orgasm and nipple stimulation have been shown to cause contractions, but do not necessarily lead to labor.  For those healthy women who wish to try anyway, we say “go for it.”  
  
by:  Gweneth Lazenby, M.D.

Request an appointment with a MUSC provider.

Sex is an important part of an intimate relationship.  Unfortunately, problems related to sex are very common. Approximately 43% of women have experienced a sexual problem.  These problems can be complicated and are arranged into categories of sexual dysfunction.  The purpose of this entry is to review the sexual cycle, the types of sexual dysfunction, and discuss approaches to treatment.

The traditional sexual response cycle (above) described by Masters, Johnson, and Kaplan includes: desire (libido), arousal (excitement), plateau (the highest point of sexual excitement and pleasure), orgasm (release of sexual tension), and resolution (latency or return to pre-arousal state). When it comes to sex, men and women respond differently. 

In general, men become aroused, develop an erection, and experience one orgasm associated with ejaculation.  This is followed by a latency period before they can become aroused again.  Women may take longer to become aroused, which is often demonstrated by vaginal lubrication, but they can experience multiple orgasms during sex with a shorter latency phase. 

In 2001, Dr. Rosemary Basson described an intimacy-based sexual response cycle (below) in order to account for the multiple factors that affect women’s desire to have sex.  In this model, a woman’s sexual arousal and desire are affected by emotional and physical satisfaction from interactions with her partner.  Once a woman feels secure, she can develop emotional intimacy and be open to sexual stimulation. 

Sexual dysfunction is a disruption of the normal sexual cycle.  There are four categories: desire, arousal, orgasmic, and pain disorders.  Each category represents a component of the sexual cycle that can be affected.  The causes of these disorders are multi-factorial, meaning that they arise from any combination physical and emotional interactions.  Women can experience more than one type of disorder from one or more categories.

Sexual desire disorders
There are two types of desire disorders.  Hypoactive sexual desire disorder is characterized by no or low interest or desire in sex.  This is often referred to as “low libido,” and it is the most common form of sexual dysfunction. Women with sexual aversion disorder avoid sex or genital contact with their partner.   

Sexual arousal disorder
Women with arousal dysfunction may have adequate interest in sex, but they are unable to maintain adequate vaginal lubrication or genital swelling in response to sexual stimulation.

Sexual orgasmic disorder
Orgasmic disorder results in a delay of or inability to have an orgasm after a normal excitement phase.  

Sexual pain disorders
There are three types of sexual pain disorders: dyspareunia, vaginismus, and noncoital.  Dyspareunia describes pain during intercourse.  This can occur during initial insertion or with deep penetration.  Vaginismus describes involuntary contractions of the vaginal muscles making penetration uncomfortable.  Noncoital sexual pain disorder or vestibulitis is characterized by pain with any touching of the outer vagina.  Sexual pain disorders can isolate a woman from her partner, because she is unable to experience sex without pain.  
 
Despite the difficulty in determining the causes of these disorders, there are identified risk factors.  Medical conditions that can contribute to sexual dysfunction are depression, heart disease, hypothyroidism, diabetes, and estrogen deficiency.  In addition, medications for the treatment of depression, high blood pressure, high cholesterol, epilepsy, and chronic pain can affect sexual function.

During a women’s lifetime, she can have periods of increased problems with sex, such as: pregnancy loss, difficulty becoming pregnant, or menopause.  Regardless of age and good health, stress can affect sexual relationships.  A woman’s desire for sexual intimacy is strongly affected by: conflict with a partner; her partner’s health; prior physical, sexual, or emotional abuse; substance abuse; and cultural or religious expectations.

Sexual disorders affect many couples.  Although this discussion is focused on the female patient, both men and women can experience sexual dysfunction.  It is important to speak to your physician concerning any symptoms you may have, especially if they are affecting your relationship or wellbeing.  In order to determine the type and appropriate treatment for sexual dysfunction, your physician will need to take a thorough history and perform an examination.  Outside of a medical exam, women with a sexual disorder should consider speaking to a counselor or therapist with training in sexual dysfunction.

by:  Gweneth Lazenby, M.D.

Request an appointment with a MUSC provider.

There is no doubt that the most effective way to prevent unplanned pregnancy is to use birth control before having sex. However, occasionally, women find themselves in a situation where they need a back up method after unprotected sex. Maybe the condom broke… or you realized you forgot to take your pill yesterday… or you got back with an ex-boyfriend before you restarted your birth control. Things like this happen. Now, there is a birth control designed for use after unprotected sex. Here are some answers to frequently asked questions about Plan B…

How does Plan B (emergency contraception) work?
Plan B contains levonorgestrel, the same hormone found in some birth control pills but at a slightly higher dose. It prevents pregnancy in one of two ways…
1. Keeps the egg from leaving the ovary.
2. Keeps the sperm from meeting the egg.

How can I get Plan B?
If you are over 18 years old, you can ask for it at your local pharmacy. You don’t need a prescription. If you are under 18, ask your doctor for a prescription that you can have with you at home in case you need it.

How do I take Plan B?
Each pack of Plan B contains 2 pills. You take both pills at the same time as soon as possible after unprotected sex. You can take Plan B up to 5 days after unprotected sex but it works best the SOONER you take it.

How well does Plan B work?
If 100 women take Plan B after unprotected sex during the fertile part of their cycle, fewer than 8 will get pregnant. Your chances that Plan B will work are higher the sooner you take it after unprotected sex.

What happens if I get pregnant after taking Plan B?
Plan B does not harm a pregnancy or cause birth defects. If you are pregnant after taking Plan B, see your doctor right away to discuss your options.

Does Plan B cause abortion?
No. Plan B has no effect if you are already pregnant. It prevents pregnancy by keeping the egg from leaving the ovary or by keeping the sperm from meeting the egg.

Can I use Plan B as my primary birth control?
It is not harmful to take Plan B multiple times. However, it is far more effective to prevent pregnancy by using many other forms of birth control before you have sex. Your doctor can help you figure out which birth control might be best for you.

by:  Angela Dempsey, M.D.

Request an appointment with a MUSC provider.